Transplant in ALL: Tailoring Treatment Based on MRD

Partow Kebriaei, MD, Department of Stem Cell Transplantation and Cellular Therapy, Division of Cancer Medicine, MD Anderson Cancer Center, provides an overview on her session at the 2024 Society of Hematologic Oncology Annual Meeting on transplant in acute lymphoblastic leukemia (ALL).

Kebriaei highlights the increasing use of measurable residual disease (MRD) as a key factor in determining the need for transplant in patients with ALL and explains that MRD levels, combined with high-risk genetic factors, are used to assess the risk of relapse and guide treatment decisions.

With the increasing effectiveness of modern therapies, Kebriaei notes that fewer patients with ALL may require transplant compared with the past. However, MRD remains a crucial tool for determining which patients will benefit from consolidation with a transplant.

Transcription:

0:09 | I spoke in the acute lymphoblastic leukemia session and my role was really to talk about the current state of transplant, or better, the role of transplant in the state of ALL therapy.

0:24 |I think more and more data would suggest that we are using measurable residual disease, or MRD, as our overarching guide to determine how much further to intensify the treatment for patients and namely that is to consolidate transplant. I think at the same time, we are learning more about the biology of the disease and determining additional high-risk genotypic subsets, so it is a balance between how high risk the patient is by genotypic or karyotypic profiling, and then MRD.

1:03 | I think both impact the risk for relapse but ultimately, MRD is a very sensitive way to assess the response to therapy so I think it is rational to use MRD to decide about consolidation with transplant. ANd the reason that we are, in general, relying less on transplant is because we have developed highly effective therapies, especially in the lineage ALL space, that can give us very deep remissions fairly early in the induction regimen of these patients so that there is a larger group of patients where we may be able to cure them without transplant.